Natural Transitionshttp://www.naturaltransitions.org
Education and support for conscious, holistic end of life choices and green, home funeralsMon, 21 Nov 2016 16:13:03 +0000en-UShourly1Good Law! How it impacts our culture of deathhttp://www.naturaltransitions.org/2016/07/08/good-law-how-it-impacts-our-culture-of-death/
http://www.naturaltransitions.org/2016/07/08/good-law-how-it-impacts-our-culture-of-death/#respondFri, 08 Jul 2016 17:18:17 +0000http://www.naturaltransitions.org/?p=1923The law is a mechanism of protection, but it can also stymie change, because it can be rooted in old paradigms.

Here’s a recent example I encountered. A group of dynamic, changemakers seeks to open an eco funeral home. Green funeral establishments are popping up around the country as a few funeral industry daredevils and holistic death educators-turned funeral directors decide to revolutionize the funeral industry from within.

The vision, akin to Bodhi Be’s Maui-based Death Store, is more than a funeral home. It is a resource center with other end-of-life complementary services, as well as green funeral care.

The funeral dynamos create a vision that pops. They begin the search for a place to locate their new business. Alas, the pickings are slim. Zoning restrictions reduce the number of properties that are appropriate for the new deathcare center.

These zoning restrictions are predicated on a view of a funeral service provider who engages in polluting, resource-intensive practices, and whose presence in any neighborhood is undesirable.

Funeral homes used to be in the heart of towns and cities (and of course, before funeral homes existed, families cared for their own in the parlor). But now, zoners have relegated them to industrial areas – and with good reason.

The entrepreneurial dynamos find a spectacular property but subsequently learn it is incorrectly zoned for a funeral service business. They appeal to the town board, explaining their “green-ness,” and the beautiful, contemplative ambience they will create, and the educational programs they will offer as a resource to the town’s residents and others.

But the law prohibits a mortuary. So what’s to be done? The town is known for its progressive stance. The board’s members are keen on the vision for this innovative business, but their hands are tied. They can’t allow this business to open because of zoning based on a paradigm that does not, in this case, apply.

This is an example of when the law inhibits cultural change. It is not an uncommon scenario. I’ve heard from a number of progressive funeral directors who have encountered the same, often insurmountable obstacles.

In NTM (Vol. 5 #1) we look at how lawmakers unknowingly limit consumer choice in the name of consumer protection. We highlight the key areas of dissent between the pros and the contras in the debate about aid in dying (also known as physician-assisted death, depending on which side of the fence you are on). And we learn the facts about who really controls the body at death from Tanya Marsh. Informing our readers and stimulating thoughtful debate, that’s at the crux of NTM’s mission. Read on!

This issue of NTM considers the pros and cons of physician-assisted death or Aid in Dying as its proponents prefer to call it. Jennifer Ballentine argues that PAD is not the solution to suffering; Bart Windrum, offers a counter argument that says it is a humane option for the dying. Tanya Marsh asks Who Controls the Dead from a legalistic viewpoint. Karen van Vuuren chats with Jon Underwood, Death Cafe founder about why creating a bricks and…

]]>http://www.naturaltransitions.org/2016/07/08/good-law-how-it-impacts-our-culture-of-death/feed/0Veterans: May their Souls Rest in Peace: Their End of Life Carehttp://www.naturaltransitions.org/2015/01/06/veterans-may-their-souls-rest-in-peace-their-end-of-life-care/
http://www.naturaltransitions.org/2015/01/06/veterans-may-their-souls-rest-in-peace-their-end-of-life-care/#commentsTue, 06 Jan 2015 18:03:55 +0000http://www.naturaltransitions.org/?p=1800May their souls rest in peace: Veterans’ end of life care. Editorial from Natural Transitions Magazine, Vol. 3 No. 4 on Veterans.

When my father, Jack was dying, he shared a story that woke me up to who he was and the reason for his restless soul. I’d never understood this volatile, charismatic Dutchman who’d shared so little of his background gorwing up in occupied Holland during World War II. But one day, a few weeks before his death, as he rested in his favorite leather recliner, much diminished by his lung cancer, I begged him for some stories about growing up in that little village in the Netherlands. That’s when, out of the blue, he blurted out, “You know, when I was 14, me and my best friend strangled a German soldier in our village.” I responded with silence, offering him space: “He (the soldier) was probably only 17 and didn’t know why he was there. But he was the enemy, and we had to take him out.”

My father’s sharing was a tacit plea for forgiveness and a re-humanization of the young German guard he had killed. He’d never spoken of World War II, which he joined after escaping and lying about his age, nor of that most intimate of killings that preceded his full-on plunge into combat. I’m so glad he got to take that one huge rock out of his backpack before he died.

We all would like to leave this life with a clean slate, complete in our relationships, having achieved “closure.” But, for veterans, the moral burden of participation in war can cause immense spiritual pain. I’ve heard Vietnam veterans even say, “I don’t deserve to heal.” For veterans who have stuffed away the horror of war, we often see how all that is unresolved rises up as they are dying.

One in four people who dies in the US is a veteran according to a 2013 VA report. Many of us do not know we are around veterans, and their wounds are equally invisible to us.

This issue of NTM considers our role in healing their soul wounds. We hear from wise teachers, Deborah Grassman of Opus Peace and Dr. Ed Tick of Soldier’s Heart. Alison Perry shares her innovative approach to veterans’ care by reconnecting them to nature on a sheep ranch, and Kandyce Powell makes a difference to the lives and deaths of veterans, including those behind the walls of Maine State Prison. May all our veterans go in peace.

Editorials customarily address the current issue of a publication, so forgive me for first writing about one that is past. The theme for Natural Transitions Magazine, volume 3 #2 was “Responding to Crisis.” How difficult that can be, considering all the variables coupled with the inability of those in the trenches of grief to think and make decisions! Not long after that issue came out, deep sadness rippled through our school community when a seventh grade student was swept to her death in the torrents of Boulder Creek. Thirteen-year-old Sophia DuBose died after the family vehicle crashed into the waters after hitting a car that had stopped to avoid a bear in the road.

Two members of our school community learned that the parents were on their way to the mortuary to “make arrangements.” It was imperative to head them off before they walked through the funeral home doors if they were to hear information about a different, potentially more healing way of marking this tragic event. The sense was that the family was open to ritual that could reconnect them to their child, carried away, first by the river, then by the coroner for a legally mandated autopsy.

Outside the mortuary, parents and friends listened as Natural Transitions’ advocates painted a picture of possibilities. There was no barrage of questions. (Questions can be overwhelming for people in shock.) Instead they simply heard, “You can go to the morgue and get Sophia when the coroner is done. You can bring her home.” Looking at the Dead in the last issue of our magazine emphasized the importance of offering those who are suddenly and tragically bereaved the opportunity to make an informed choice about viewing their dead. This family chose, unequivocally, to reclaim their daughter, supported by caring, courageous members of their community.

It takes courage to change attitudes and conventions that are rooted in fear. Fear is the reason for our disconnection to death. Imagine the courage it took (and the love) for Sophia’s family to retrieve their daughter from the morgue? Imagine the courage and incredible capacity for service for school parents to step in and assist the family in laying out their precious child.

In this isue of NTM, Lee Webster features just a small selection of the lesser known, courageous movers and shakers who are changing the paradigm around death, inviting us to overcome our fear and reestablish an affirmative relationship to our mortality. Potter, Julian Stair’s anthropomorphized funerary art provocatively asks: what is your relationship to death? Brit, Jon Underwood’s Death Cafe idea proliferates beyond his wildest imagination (Why I go to the Death Cafe by Holly Pruett). This issue of NTM is about bringing death into view, responding to it in the most heart-centered way, lest we forget its part in life.

]]>http://www.naturaltransitions.org/2015/01/06/the-courage-to-be-with-death-movers-and-shakers/feed/0Responding to Crisis: The Good, the Bad and the Uglyhttp://www.naturaltransitions.org/2015/01/06/responding-to-crisis-the-good-the-bad-and-the-ugly/
http://www.naturaltransitions.org/2015/01/06/responding-to-crisis-the-good-the-bad-and-the-ugly/#respondTue, 06 Jan 2015 17:36:09 +0000http://www.naturaltransitions.org/?p=1788Responding to the Good, the Bad, and the Ugly by Karen van Vuuren, Editor, Natural Transitions Magazine. (Letter from the Editor for Vol. 3 No. 2 Responding to Crisis.)

Noah Pozner’s mother chose to see his body after he was killed in the Newtown, CT school shooting of 2012. She felt that she, “owed it to him as his mother” to be with him through the “good, the bad, and the ugly.” The viewing happened at the funeral, as he lay in a box, looking “like he was sleeping.” She described how his thick, shiny black hair lay on a pillow, his “beautiful, long eyelashes” resting on his cheeks.

Noah’s mother was one of the few Newtown parents to see their child once the bodies were released for cremation or burial. After the massacre, Chief Medical Examiner, Dr. H. Wayne Carter II, allowed families to identify their children from photographs rather than permitting access to the remains. In his opinion, it was “easier on the families” to do it this way.

Blog posts soon appeared raising questions about the authority of the medical examiner to restrict access to the dead. How hard must it have been for those grief-stricken parents to be separated from their children? Yes, coroners and medical examiners have the right to bar individuals from “the scene” and from the victims’ remains, if this may compromise an investigation into the cause and nature of death, especially at a crime scene. But should officials have the right to determine whether a body is viewable?

The edited research article from the British Medical Journal Looking at Death (our title), was the inspiration for this issue of NTM Responding to Crisis. The authors consider whether officials should encourage or discourage viewings after traumatic death, or whether they should promote informed choice.

Grief that arises after sudden death can be more complicated simply because no-one had a chance to prepare. There were no advance farewells, reconciliations, confessions of love, all of which can bring closure to life. So the aftermath of death is of even greater significance. In cases of unexpected bereavement, families may experience an even more urgent need to find closure and resolution. Compassionate support staff like victim advocates and grief counselors can make a difference, helping families find opportunities, not simply to survive and cope with loss, but to integrate and heal from it.

A person’s essence is present in all states of consciousness, during times of wakefulness, sleep, delirium, dementia, coma, near-death, and dying. This belief inspires our work in coma communication, the art of cherishing and connecting with people seemingly unable to communicate. Arnold Mindell, (who along with Amy Mindell is my teacher), says that near death, people are “wakeful human beings going through one more meaningful step in their process” and that many people in comas “venture to the heights and depths to find some degree of ecstasy, prophetic insight, and self knowledge.” Mindell believes that at death, “people are prepared more than ever to live fully.”

In living into dying, we have the opportunity to cross thresholds and enter new worlds of experience through our altered state of consciousness. We continually change our consciousness through meditation and prayer, yoga and dance, walking, running, and even by loving and fighting. During the dying process, our transformation may be profound. The quiet person might share, the grump, love, the extrovert become introverted, and the kind person grow in kindness. An attentive person may lose interest in their outer life and instead focus on their inner life. The heart can open wider than ever before. Our role as carers is to find ways to support opportunities for transformation in those who are living as they die.

Coma communication provides a template for us to map uncharted landscapes when familiar patterns of relating have ceased and communication seems impossible. The work is cross-cultural and uses non-verbal methods to frequently create extraordinary and unexpected moments of meaning, relationship, and awareness. Although death may be difficult or painful, it can also be an ecstatic experience filled with radiance and love. It can be a time when important events occur within us.

Near end of life, there are four main themes people tend to explore. They review their life story, fight heroic battles, process relationships and deep loves, and sometimes they open the door of their spiritual heart. In experiencing these inner and outer processes, people may see (what and who is around them or have inner visual experiences and memories), feel (have bodily sensations), hear (inside and outside of themselves), move (in response to inner and outer events), relate (with inner figures or outer people and world events).

Altered consciousness and dying allow us to explore little known or expressed aspects of ourselves. We may shoot rays of love to the estranged child bringing peace to both of our lives. We might run like hell, arms and legs flailing, dodging the bullets of war in our delirium, revealing our energy, strength, and courage, even as our body is failing. We might say or do things we never thought possible, even if it is just reaching out to give a hug. Long after he had seemingly forgotten his son, my life partner, Stan’s father reached out and stroked his son’s hair. Stan’s father had advanced Alzheimer’s, and had not hugged his son since Stan was twelve.

To the onlooker, the dying person is changing in front of them, melting away, altered in consciousness and ability, and possibly so different to the person we knew and loved. For the carer, it can be hard to tell what, beyond dying, is going on.

As communication carers, our role is to find a way to be with and to further a person’s inner and outer dying process. We assist when invited, and our passion is to relieve the isolation felt by the dying person and their loved-ones. People are often more afraid of being trapped in “weird” states of consciousness than they are of death itself. When someone no longer talks, we can easily become shy or nervous. There can even be an urge to leave the room to escape the feeling of not knowing what to do.

When someone is delirious, we can say things like “I’m not your mother, I’m your daughter” in the hope the person will return to themselves. If that fails, a next step might be to become that “mother,” bringing forth positive mothering qualities, such as tenderness and sensitivity. In this way, we use the “mistaken identity” as a vehicle and a metaphor for what might be the next step this person needs for their journey.

Our role is to accompany the dying as they experience the various weather systems of their dying process: calm seas to wild winds, drought to rain, overcast skies to sunshine. “Please be with me as I am, how I am, for as long as this takes,” they ask of us.

There are many wonderful ways to be with the dying. We might take time to gather around the bed, holding our loved-one’s hands and telling them we love them. Or, we might say, “It’s been quite a ride over these years!” We might hum or sing a family song, or a favorite tune from their era. A man once told his buddy and drinking partner, “I’ll keep our secrets, my friend.” He then sang a simple tune and was joined by members of the family. We noticed this created a feeling moment of union in the midst of the family’s grief, so we encouraged them to keep singing, which they enthusiastically welcomed. When we sit with awareness, we can respond to changes in the room and encourage and model these healing moments.

Stan and I were at home when we received an emergency call from a family we did not know. The caller informed us, “Our Dad is in the hospital with a stroke. He’s only 54 and in intensive care. We want to do everything we can to help him. The whole family is flying to be with him,” The caller had heard that we worked through visual Skype, reading signals coming from a person even when they are in a coma, and that we could enhance communication beyond what is often considered possible. Desperation and death opens strangers to each other, and we were welcomed as long lost friends by this family.

Entering an ICU is always shocking. The patients are in trouble. The family was gathered in the room and talking in groups of two or three. We could see and feel the fear and chaos along with the yearning to find new ways to connect. As their loved-one lay in a coma, we invited the family members to gather around the bed of the patient. They were relieved to have some guidance, and to be nearer their father, brother, uncle. A hush naturally descended and we encouraged everyone to pay attention to the patient’s breath and to breathe with him. In doing this, they spontaneously reached out for each other and laid their hands on their loved one. The atmosphere softened. Later that night, the patient died, bathed in his family’s love.

Breath is a vehicle for establishing deep connection and feelings of rapport. It is a bridge that allows us to join a person who is in an altered state, beyond country, culture, language and belief. We all have breath in common.

You can breathe with a person for a few breaths. Breathe into the same place in your body that they are breathing into — upper chest, belly, diaphragm. If the breathing is too fast, slow, or shallow for you to keep up with them, it is still worth trying, if only for a brief time, because it is a way for you to be able to enter into their experience. Give yourself permission to do with your breath, what you observe in the other. This may be new for you, but it is straightforward to learn.

Another way to connect using the breath is to speak when the patient is exhaling. You might only be able to say a few words at a time, slowing down your speech to a pace where the person is more able to follow you. For example, speaking on their out-breath you might say, “I am here . . . with you . . . we are in this together . . . forgive me . . . I forgive you . . .thank you . . . I love you.” Your inner attitude and healing words can include, “Believe in your experiences they are meant for you.” This opens up worlds of possibility and provides a sense of relief for all.

Each time you speak, notice if anything changes in the person who is dying. Do they take a deeper breath? Do their eyelids flicker? Does a feeling of peace enter the atmosphere? Does the sun burst into the room? These can all be signals of response from the patient. We are all in a great field together. If you ask, “How are you?” and a plate crashes in the hallway, you might bring that to the bedside and say something like, “Things are crashing!” Then watch to see if there is any response, any tiny or large change in the person. If there is, you have found each other in some “magical” way that is non-linear and meaningful. Remain open to taking the “conversation” further. For instance, if the person’s arm moves, even a little, “Yes, that left arm is wise. Follow its movement. It will show you the way.” Provide plenty of positive encouragement, watching carefully to check if you are speaking “their language.” If you notice that the patient’s arm moves more, their eyelids flutter, their mouth shifts slightly, they swallow or water comes from their eyes, encourage them more. You could say something like, “Ah, moving!” or “Feel what you are feeling as you move,” or “Water coming from your eyes.”

Use every signal as a potential portal for communication and conversation with the soul of the other. Try to be neutral, using what we call “blank access words” to encourage open-ended exploration and awareness. Ifnothing changes, sit and wait for the next moment of possibility. There will always be another chance. You too, might need to take a break.

“Pacing the breath” is another way of working with breathing. Inform your client or loved-one before you touch them, then place your hand on the back of their hand, their wrist, shoulder, or ankle. Watch for the next inhale and then squeeze gently as they inhale. This meets the expansion of the patient’s inhalation. As the person exhales, relax your hand while maintaining contact, allowing you to connect gently but strongly with those in deep, inner states. As the person inhales, squeeze again. As they exhale, relax. You can practice this on yourself first to get the hang of it. This is a calming and centering practice that draws you inwards. When practiced on someone else, it can deepen and amplify sacred connection.

“Pacing the breath” can also include sounds or sighs, even those of patients on ventilators. If someone is moaning, we can moan with them, a little bit louder and longer. This helps them to perceive that we are willing and able to speak their language. With children, we do this all the time, making sounds and pacing our reactions in accordance with the expressions of the child. So too with the dying. Sometimes, incoherent sounds, fed back with compassion, are the feedback the person needs to make the thoughts inside their head come out in a way that is understandable. This was the case with one woman who had been speaking gibberish. After hearing her sounds lovingly reflected, she found her way to saying clearly, “I’m ready now. May I go?” We could then respond directly, “You can stay or you can go, whatever is right for you.” She took one more breath and left.

Following a stroke, a man could only make loud, raucous noises. His family members were anxious that this was from pain. We encouraged them to say their goodbyes. We noticed that whenever someone said, “I love you,” the loving father let out a loud mountain-sized roar from deep within. The roar was his best attempt at echoing back, “I love you.” Reframing his roar changed the atmosphere in the room from anxiety and fear to excitement, wonder, and closeness. The family stories of appreciation for their father’s life began pouring out.

Sometimes what appears to be pain is the beginning of an expression of profound joy. After we had been breathing with a dying woman for a few breaths, she began to quiver and grimace. Her daughter’s first thought was, “Oh, she is in pain!” “I don’t know your mother, is that how she looks when she is in pain?” I responded, staving off the rush to “do something, anything.” With the daughter’s permission, I told them both what I was about to do and placed one of my hands under the mother’s elbow and the other under the wrist of the arm that had quivered. In Coma Communication, we contact bony structures to facilitate rather than to impose on muscle movements. This gives the person an opportunity to move freely, even if they no longer have the strength to move on their own. The dying mother’s frail arms, now supported, began rising up over her head, her face bursting into an ecstatic beam, lighting up the whole room, her eyes gazing attentively upward. The daughter, relieved and grateful to see her mother doing so well during these last moments on earth, envisioned her mother, greeted by the love of her spiritual guide.

There are so many ways we can be with the dying, joining with them, cherishing and connecting with them. Each moment is precious and it is a privilege to be with all that is present: wonder, pain, love, joy. Hearts beating together, even as one heart is stopping.

This article is reprinted from Vol3#1 Communication of Natural Transitions Magazine. Subscribe and join our community.

JOIN OUR BOULDER WORKSHOP that is on Day 2 of Natural Transitions’ FILM FEST plus.October 13, 2013, Boulder, CO. More information HERE.

References:

Coma Work and Palliative Care: A Communication Skills Manual for Supporting People while Living in Delirium, Vegetative State and Coma. Stan Tomandl

Coma: The Dreambody Near Death. Arnold Mindell

Ann Jacob is a coma communication counselor, consultant, and trainer based in Victoria, British Columbia, Canada. She works with her partner, Stan Tomandl. Jacob is also a faculty member of the Sacred Art of Living and Dying Center.

]]>http://www.naturaltransitions.org/2013/09/11/coma-communication-reading-the-signs/feed/0The spirit in Alzheimer’shttp://www.naturaltransitions.org/2013/07/19/the-spirit-in-alzheimers/
http://www.naturaltransitions.org/2013/07/19/the-spirit-in-alzheimers/#respondFri, 19 Jul 2013 15:34:33 +0000http://www.naturaltransitions.org/?p=1471The following article on the spiritual aspects of Alzheimer’s by Megan Carnarius and is excerpted from an article published in Volume 3#1 of Natural Transitions Magazine (Communication). To sign up for the free e-version of our magazine – fill out the Contact Form on the Natural Transitions website. A high-quality print version of the magazine is also available for purchase. Please visit our Advertising page for details of how to reach our unique audience with your product or service.

Further lessons in letting go and compassion.

For me, Alzheimer’s is about transition and transformation, not about decline. It’s shedding and letting go, and moving into the next reality. For some reason, end of life for people with dementia includes this “wafting off” experience. As caregivers, we sometimes have discussions about whether residents will remember their time with us after they have left their bodies. I say, “Well, they might look back and think they were living in a weird fraternity house for a while!” In truth, mysense is that our inner work with them is what they will take with them when they die.What counts are our intentions, our goodness, and our wish to interact with them. This is what will somehow find itself into their life review when they transition.

As caregivers, we have been put in charge of the bodies of those with late stage Alzheimer’s. We provide water for them when they wake as we would for a monk in deep meditation. As their disease progresses, there’s a kind of quiet and peaceful depth these people enter. To a large degree, they live in this “depth” during the latter phases. It almost feels like a rude interruption, attempting to rouse someone who’s been very busy, even though they’ve been sleeping.

People with mid to late-stage Alzheimer’s often talk about relatives who have died. They’ll say, “I’ve seen my mother.” This phrase conveys, “I just had a wonderful conversation with her.” Who am I to say they’re wrong? When delusions and hallucinations occur with dementia, we have to make sure that the person is not physically ill or that their medicine isn’t causing problems. With these ruled out, there is often still a spiritual aspect to these visions and feelings because the threshold for those with Alzheimer’s has thinned. People can often cross back and forth from the here to the hereafter because of the deep and loving connections they have to others.

I think of myself as a compassionate person, and I felt like I knew a lot about this work. But losing my mom (that sounds weird because I know she’s around, although I have “lost” her in the physical form), not having this best friend to talk to, made me much more raw when I interacted with other families. That led me to consider the following: that which makes us more compassionate usually involves the experience of something profoundly painful. Losing my mom afforded me a greater understanding of loss. Getting diabetes woke me up in another way.

I’d always rated myself as healthy. Then I had the flu, and a virus settled into my pancreas and started killing off my insulin-producing cells. I ended up with type I diabetes. Although I’m a nurse, I didn’t even know one could get that kind of diabetes from a virus. Suddenly, I had to watch my blood chemistry. I realized that I had not been paying attention to myself at all. Diabetes and “sticking myself” regularly, forced me to shift gears. I wish I hadn’t had to learn to do it this way, but it was part of the dynamic I needed. I could have said, “I just got the virus and everything was accidental,” but there’s a part of me that just doesn’t believe that. Why was I vulnerable to that virus and someone else wasn’t? I got it, so what am I supposed to be doing with it? So I try to pay attention to when I’m not mindful of myself because it’s much easier for me to tune in to the other person. I’m like a giant satellite dish. Megan’s available! “What’s going on with you and how can I make your life better?” I have to turn the same attention to myself.

Life recapitulation and review

When someone with Alzheimer’s gets to the stage where they lose fine motor skills, they’re letting go at a fundamental level, so they can cross the threshold. In essence, they’re leaving as they came in (without these physical and mental facilities). There’s a kind of intense spiritual purity about that. The word “occult” speaks of that which is hidden. What is real in our reality and what isn’t? The experience of Alzheimer’s and memory loss is very stark and raw. If I can’t talk to you about my stories, does that mean I’m not here? I don’t have value? We can, however respond with “No, you’re a whole spirit having a handicapping experience.” Those were my mother’s words about my younger, disabled sister. In this life time, we may have grown up, worked a job, raised a family, and “done what was expected.” Then we go through this handicapping phenomenon that causes us to recapitulate our life and review it. We might ask, “What are some of the things you could access through your dementia that you couldn’t have otherwise?” Here are some examples.

Two spouses came from a generation where you married and never divorced. Theirs was a very difficult relationship because the wife had severe depression and the husband was always trying to fill in the gaps. He wanted to make her feel better, but he often felt angry at this role. The husband was in his eighties when his wife’s clinical depression intensified, and she was also declining physically. Around the same time, the husband started to exhibit dementia. When I met him, I had such a strong sense of his inner stance, one of “I must stay! I must be here!” He couldn’t physically remove himself from the situation. He couldn’t say, this hasn’t worked! I need to go on to something else. He was so committed to the dynamics of the relationship. Then, as soon as his wife entered the nursing home, and he was in a memory facility struggling with his dementia, he started getting clearer. He was able to talk with lucidity about many things. Until then, he’d had no idea how to create a different space for himself, so he could perform a different kind of role. We know that some people suddenly develop a terminal illness when they retire because they cannot redefine themselves. Dementia gave this man an opportunity to review his role in life, and the ability to grieve.

Dementia can also transform strong matriarchal and patriarchal roles in families. The dementing experience can allow people to let go of behavior patterns. Children who have never felt empowered, who have always looked to the parental figure, can find that everything is slowly handed over. By the time the patriarchal or matriarchal parent is dying, the parent knows that their kid is safe and able to function as a responsible adult. Alzheimer’s facilitates this shift in view. If death had come suddenly to the parent, the shock may have further disempowered the child. A gradual transition allows the child an opportunity to pick up the reins.

It’s up to us to remain awake to the spiritual experience of the person with a dementing illness.For the caregiver, it’s a path to learn compassion and introspection; a spiritual opportunity. Our task is to hold people with dementia in our consciousness — when they are “unavailable” to us in the conventional sense.

Our society often disqualifies people with dementia or disregards them. Dementia-ism as well as age-ism exists, and I’ve spent my career distancing myself from both. Who are we to say that those with dementia and Alzheimer’s are not experiencing something holy?

Working with the process of dementia or Alzheimer’s is a lesson in impermanence for me. We all know that things change, and life moves us into unimaginable experiences. Some of these are good. Others, at first glance appear as bad. It is easy to trust the flow of the universe when events bring joy, happiness, or ease to our lives. It is much harder to embrace the painful things, which challenge us deeply and make us grow. Alzheimer’s has been called the “plague” of modern times, and we often view it with fear. But I believe that our bodies are physical homes for our spiritual being, and this spiritual essence remains eternal and unchanged. We are much more than “the matter” of our brains.

]]>http://www.naturaltransitions.org/2013/07/19/the-spirit-in-alzheimers/feed/0Communication creates compassion creates communityhttp://www.naturaltransitions.org/2013/06/25/communication-creates-compassion-creates-community/
http://www.naturaltransitions.org/2013/06/25/communication-creates-compassion-creates-community/#respondTue, 25 Jun 2013 02:45:05 +0000http://www.naturaltransitions.org/?p=1450Earlier this year, I, Karen van Vuuren, editor of Natural Transitions Magazine, was sitting in Patricia Kelley’s living room in her modest Victorian-era home. Kelley, a doyenne of the field of end-of-life communication, is mostly known for her first book, Final Gifts, which she co-authored with fellow hospice nurse, Maggie Callanan and published in 1992. Kelley, a cheerful, snowy-haired Brit, who is semi-retired, informed me that her book is still a bestseller, nationally and internationally.

We reflected on the success of Final Gifts. In those days, Kelley’s literary agent pitched it to slew of publishers, auctioning it to the highest bidder. The book’s contents — an expose of what patients are telling us in their dying process — were novel then, and so interest was high. If Kelley’s book were to hit the bookstores for the first time now, we’d find it nestling alongside countless other publications on understanding death and dying. That’s progress!

This issue of Natural Transitions Magazine focuses on “communication.” How we communicate with the dying, and how we communicate with each other around death. “Communication,” derives from the Latin verb “communicare,” meaning to impart, share, or make common. The related noun is “communis, literally “that which is common.” Communis is closely related to the word “community.”

Some wit once said that you can’t have a community without communication. In other words, communication begets understanding and compassion, which begets community. Natural Transitions Magazine is building community through our magazine. We hope you will savor this issue’s illuminating articles on end-of-life communication from educators like Ann Jacob (coma and “unresponsive” states) and Megan Carnarius (dementia from a spiritual perspective), as well as from others who are changing the end-of-life care paradigm.

]]>http://www.naturaltransitions.org/2013/06/25/communication-creates-compassion-creates-community/feed/0Life after death: What to expect when we diehttp://www.naturaltransitions.org/2013/03/19/life-after-death-what-to-expect-when-we-die/
http://www.naturaltransitions.org/2013/03/19/life-after-death-what-to-expect-when-we-die/#respondTue, 19 Mar 2013 16:55:34 +0000http://www.naturaltransitions.org/?p=1175This article is from an editorial in Volume 2 Issue 4 of Natural Transitions Magazine: Life after Death.

Our fear of death is foremost a fear of the unknown. By the time we reach death’s door, most of us in the Western world will have given scant thought to what lies beyond our material existence — because the pursuit of the material has been our primary focus. Religiosity does not necessarily provide us with a roadmap to the afterlife either (although some traditions, notably Buddhism and esoteric Christianity, describe the after-death landscape in vivid detail).

How appealing it is then to think that science might be able to verify the experience of life after death. Proof of Heaven: A Neurosurgeon’s Journey into the Afterlife by Dr. Eben Alexander has topped the New York Times bestseller list for weeks. Even my teenage daughter, who ordinarily would not willingly consume any book about death, was hooked by the title (and it is a very good one!). In passing my bookshelf, she pounced on the copy I had finished reading moments before, then maneuvered herself, nose in book, to the couch. Hours later, she was still immersed in Dr. Alexander’s account of his extraordinary out-of-body journey during an illness in which his brain was completely shut down. My daughter’s interest in matters beyond this life is emblematic of a growing spiritual yearning within our society to understand more of the non-physical world and, in so doing, remove the fear that stops us both living fully and dying with greater ease.

Not long after reading Dr. Alexander’s book, I found myself listening to an NPR interview with Dr. Sam Parnia, resuscitation specialist and author of Erasing Death: The Science that is Rewriting the Boundaries between Life and Death. While Dr. Parnia has concentrated his research on improving and standardizing resuscitation techniques, he has also initiated a project to document the near-death experiences of resuscitated patients. The patients in Dr. Parnia’s studies have all, “objectively died.” Their hearts have stopped and their brains have flatlined. Paradoxically, even though his goal has been to improve our odds of beating death, Parnia’s big take away is that “we no longer need to fear death.” He states this with absolute certainty after hearing countless stories of compassionate, loving beings greeting his patients when they die. In Dr. Parnia’s view, death is not so bad after all, except it seems for those of his patients who have attempted suicide. Of those he has resuscitated, reports of painful and distressing after-death experiences are universal.

This issue of NTM includes exceptional, thought-provoking accounts of life beyond our last breath. Christopher Sassano, after four near-death experiences, assures us that “death is absolutely safe.”

Patsea Cobb calms her dying mother (a near-death experiencer) with a reminder that death is familiar territory. Patricia L’Dara provides comfort to the dying by shepherding them across the threshold. Whatever we believe about what happens when we die, it may be easier if for us if we believe “something” rather than nothing. If we can create our own story – a story that gives meaning to life and makes sense of death, then the realm beyond the veil may no longer appear as a scary void – this great unknown that gives rise to our deepest fears.

]]>http://www.naturaltransitions.org/2013/03/19/life-after-death-what-to-expect-when-we-die/feed/0Caregiving and Receiving – we need to share the carehttp://www.naturaltransitions.org/2012/11/30/caregiving-and-receiving-we-need-to-share-the-care/
http://www.naturaltransitions.org/2012/11/30/caregiving-and-receiving-we-need-to-share-the-care/#respondFri, 30 Nov 2012 20:42:01 +0000http://www.naturaltransitions.org/?p=1065The following post an editorial by Karen van Vuuren from Vol2#3 of Natural Transitions Magazine: Caregiving and Receiving.

Suddenly, there was not enough of me to go around. Over the course of a week, I’d received pleas for help from three friends with relationship crises, two with broken limbs, and one with a life-threatening illness. On the home front, I was trying to avoid being sucked into my own minor maelstrom with my high school senior as she prepared for exams and completed college applications. I felt guilty and frustrated that I simply couldn’t do it all. The irony was not lost on me that, at the same time, I was also putting together this issue of NTM with its focus on caregiving and receiving.

Sharing the burdens and the blessings of supporting those in need is more important than ever, for both our personal physical and mental well-being and our social and cultural health. When our family support networks and our financial resources fall short of our needs, we must create these new support communities. Share the Care founder, Sheila Warnock, has long exhorted Americans to “return to the barnstorming mentality of yesteryear,” and she repeats her call for community in her article for this issue, Don’t Do It Alone!

We’ve devoted much of this issue of NTM to the caregiver’s needs. But clearly a healthy caregiving scenario, in which the caregiver does not buckle under the weight of his or her role, will positively impact the care recipient as well. Although the newly coined diagnosis, Caregiver Stress, is not yet in the Diagnostic and Statistical Manual of Mental Disorders, it is increasingly acknowledged and recognized by medical professionals. Exhaustion, depression, anger, guilt, and a decline in one’s own health can all dog the caregiver who experiences “unrelieved” caregiving. This issue of NTM is in honor and support of those who care for the sick and the dying—and for the newly emerging circles of those who care for the dead (see Undertaking with Love and Quaker Burial Societies: Departing in the Company of Brethren). Please SUBSCRIBE to Natural Transitions magazine and send your comments and story ideas to us.

]]>http://www.naturaltransitions.org/2012/11/30/caregiving-and-receiving-we-need-to-share-the-care/feed/0Natural Transitions Magazine issue on Children and Deathhttp://www.naturaltransitions.org/2012/08/24/natural-transitions-magazine-issue-on-children-and-death/
http://www.naturaltransitions.org/2012/08/24/natural-transitions-magazine-issue-on-children-and-death/#respondFri, 24 Aug 2012 03:41:09 +0000http://www.naturaltransitions.org/?p=936A frail, exhausted octogenarian dies and we muse on his consummate life. He’s made it through childhood to old age, and the finishing post is death. Grief and sadness arise, but he had a “good inning” (or that’s the hope). Not so with the demise of a child. We expect our progeny to flourish, to enter adulthood, to thrive and outlive us, and when they don’t, the natural order of things is undone. It’s a generalization, but that’s mostly how we see it. Our editorial team braced itself for tears with this issue of Natural Transitions Magazine. If death is still largely a taboo topic in this culture, child death is probably the hardest to broach. Bereaved parents often feel the discomfort of others who don’t know what to say or do around them.

It’s not just lay people who don’t know what to do or say when a child is dying or has died. Many healthcare professionals, including hospice staff, feel inadequately trained to serve terminally ill children and their families.

In research for Vol.2#2 of Natural Transitions Magazine, I came across the work of Children’s Hospice International (CHI), whose mission is to encourage the inclusion of children in hospice, palliative, and home care programs. The organization has provided invaluable education and training to enhance services to families with terminally ill kids. In 1983, when CHI began, only four hospices in the US accepted children. Now, most hospices are at least open to serving children. Unfortunately, many hospices still do not feel well equipped to deliver pediatric care.

Getting families with dying children to even consider hospice is another monumental challenge. If choosing hospice means handing parents an ultimatum to stop treating their child’s disease, hospice frequently doesn’t stand a chance. Families of very sick children most desperately want them to live. Terminally ill kids generally receive more aggressive treatment than adults with similar diseases. Moreover, physicians often find it difficult (medically speaking) to hand out the six-month prognosis of probable death that is typically required for hospice eligibility.

CHI has been instrumental in promoting the option of concurrent curative and palliative care from the time of diagnosis, available through the Medicaid waiver. (See our article Entering the Mainstream: Pediatric Palliative Care Comes of Age.) A gifted palliative care team can act as a bridge to hospice, introducing the hospice concept, helping families to evaluate treatment options holistically (for example, their impact on quality of life), and even introducing the “what if” scenario of death.

This summer issue of Natural Transitions Magazine isn’t just about child death; it’s also about how children experience the deaths of others. Intuitively, I’ve always felt this hinges a great deal on how we adults deal with mortality. Read our contributors’ views on exposing children to the way of all things—death. And then read how we can help them to experience healthy grieving.